BrainWaves: A Neurology Podcast

Latest Episodes:

Quanta: Foot drop Oct 18, 2018

Show notes

What do gardeners and snow skiers have in common? Well, besides the fact that both tend to enjoy the outdoors, it turns out they are also at an increased risk of peripheral nerve injury. This week on the podcast, we review the anatomy and pathophysiology of several of the most common sites of nerve damage in the lower extremity.

Produced by James E. Siegler. Music by Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8:158-69.
Baima J and Krivickas L. Evaluation and treatment of peroneal neuropathy. Curr Rev Musculoskelet Med. 2008;1:147-53.
Marciniak C. Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil Clin N Am. 2013;24:121-37.

#122 I wonder: Bias in clinical research Oct 11, 2018

Show notes

As the name suggests, "evidence-based medicine" is dependent on published evidence to support our clinical practice and medical decision making. Implicit in this is the notion that all published evidence reflects the truth that underlies the biology, pathophysiology, and pharmacology of our health.

This is not the case.

Clinical research and published findings can be extremely limited, and what you read in Lancet and NEJM should be interpreted with caution. In this week's episode of the "I wonder" series, where Jim Siegler speaks with Ali Hamedani on various topics in medicine and neurology, the speakers review the major biases inherent to the practice and interpretation of clinical research.

Produced by James E. Siegler. Music by Jahzzar, Kai Engel, and Lee Rosevere. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet. 1988;2:349-60.
Smith GC and Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. Bmj. 2003;327:1459-61.
Kazui H, Miyajima M, Mori E, Ishikawa M and Investigators S-. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. The Lancet Neurology. 2015;14:585-94.
Montalban X, Hauser SL, Kappos L, Arnold DL, Bar-Or A, Comi G, de Seze J, Giovannoni G, Hartung HP, Hemmer B, Lublin F, Rammohan KW, Selmaj K, Traboulsee A, Sauter A, Masterman D, Fontoura P, Belachew S, Garren H, Mairon N, Chin P, Wolinsky JS and Investigators OC. Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis. The New England journal of medicine. 2017;376:209-220.

#49 Intro to CSF analysis Oct 04, 2018

Show notes

There is nothing mysterious about the chemistry of the cerebrospinal fluid. Cells. Protein. Glucose. But the interplay of these unique components can give you incredible insight into the state of the central nervous system. This week, we revisit a prior episode where Dr. Mike Rubenstein reviews his approach to interpreting CSF results. And then we have an update at the end regarding recent advances in CSF analysis.

Produced by James E. Siegler and Michael Rubenstein. Music by Steve Combs. Sound effects by Mike Koenig, Daniel Simion. Voiceover by Patrick Green (German). BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. If you like what you hear, let us know and rate the show!

REFERENCES

1. Frederiks JA and Koehler PJ. The first lumbar puncture. J Hist Neurosci. 1997;6:147-53.

2. Seehusen DA, Reeves MM and Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003;68:1103-8.

3. Shah KH and Edlow JA. Distinguishing traumatic lumbar puncture from true subarachnoid hemorrhage. J Emerg Med. 2002;23:67-74.

4. Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, Sellebjerg F and Force ET. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2006;13:913-22.

5. Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Hausler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C and Gilden DH. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008;70:853-60.

6. Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL and Dominguez SR. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Annals of neurology. 2016;80:326-38.

#121 Pain in the eye Sep 27, 2018

Show notes

When is eye pain an ophthalmological issue, and when is it a neurological issue? This week, neuro-ophthalmologist and glaucoma specialist Dr. Ahmara Ross simplifies ocular pain for the day-to-day neurologist.

Produced by James E. Siegler and Ahmara Ross. Music by Yan Terrien, Unheard Music Concepts, Steve Combs, and Scott Holmes. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Fiore DC, Pasternak AV and Radwan RM. Pain in the quiet (not red) eye. Am Fam Physician. 2010;82:69-73.
Lee AG, Al-Zubidi N, Beaver HA and Brazis PW. An update on eye pain for the neurologist. Neurol Clin. 2014;32:489-505.
Waldman CW, Waldman SD and Waldman RA. A practical approach to ocular pain for the non-ophthalmologist. Pain Manag. 2014;4:413-26.
Friedman DI. The Eye and Headache. Continuum (Minneap Minn). 2015;21:1109-17.

Quanta: The TOLEDO trial Sep 20, 2018

Show notes

Apomorphine has a more than 20 year history as a therapeutic adjunct in the management of idiopathic Parkinson Disease. And yet, no randomized, placebo-controlled clinical trial to show for it.

As of July 2018, now there is. In this week's episode of BrainWaves, Dr. Siegler discusses the relevance, the strengths, and the weaknesses of the recently published TOLEDO trial.

Produced by James E. Siegler. Music by Ondrosik and Rod Hamilton. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

1. Katzenschlager R, Poewe W, Rascol O, Trenkwalder C, Deuschl G, Chaudhuri KR, Henriksen T, van Laar T, Spivey K, Vel S, Staines H and Lees A. Apomorphine subcutaneous infusion in patients with Parkinson's disease with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-controlled trial. The Lancet Neurology. 2018;17:749-759.

#120 Fungal brain disease Sep 13, 2018

Show notes

In 2012, more than 13,000 Americans were inadvertently exposed to contaminated medical equipment, resulting in one of the largest fungal outbreaks in US history. Despite rapid mobilization by the CDC and FDA, 751 patients died from complications of fungal brain infections.

But this is more the exception than the rule when it comes to fungal infections of the central nervous system. This week on the BrainWaves podcast, we review the common (and uncommon) clinical, radiographic, and diagnostic features of fungal brain disease. Enjoy!

Produced by James E. Siegler. Music by Jahzzar, Swelling, The Insider, and Chris Zabriskie. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Kainer MA, Reagan DR, Nguyen DB, Wiese AD, Wise ME, Ward J, Park BJ, Kanago ML, Baumblatt J, Schaefer MK, Berger BE, Marder EP, Min JY, Dunn JR, Smith RM, Dreyzehner J, Jones TF and Tennessee Fungal Meningitis Investigation T. Fungal infections associated with contaminated methylprednisolone in Tennessee. The New England journal of medicine. 2012;367:2194-203.
Smith RM, Schaefer MK, Kainer MA, Wise M, Finks J, Duwve J, Fontaine E, Chu A, Carothers B, Reilly A, Fiedler J, Wiese AD, Feaster C, Gibson L, Griese S, Purfield A, Cleveland AA, Benedict K, Harris JR, Brandt ME, Blau D, Jernigan J, Weber JT, Park BJ and Multistate Fungal Infection Outbreak Response T. Fungal infections associated with contaminated methylprednisolone injections. The New England journal of medicine. 2013;369:1598-609.
McCotter OZ, Smith RM, Westercamp M, Kerkering TM, Malani AN, Latham R, Peglow SL, Mody RK, Pappas PG and Chiller TM. Update on Multistate Outbreak of Fungal Infections Associated with Contaminated Methylprednisolone Injections, 2012-2014. MMWR Morbidity and mortality weekly report. 2015;64:1200-1.
Schwartz S, Kontoyiannis DP, Harrison T and Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. The Lancet Neurology. 2018;17:362-372.
Benedict K and Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis. 2014;20:349-55.
Brouwer MC, Tunkel AR, McKhann GM, 2nd and van de Beek D. Brain abscess. The New England journal of medicine. 2014;371:447-56.
Wilson MR, O'Donovan BD, Gelfand JM, Sample HA, Chow FC, Betjemann JP, Shah MP, Richie MB, Gorman MP, Hajj-Ali RA, Calabrese LH, Zorn KC, Chow ED, Greenlee JE, Blum JH, Green G, Khan LM, Banerji D, Langelier C, Bryson-Cahn C, Harrington W, Lingappa JR, Shanbhag NM, Green AJ, Brew BJ, Soldatos A, Strnad L, Doernberg SB, Jay CA, Douglas V, Josephson SA and DeRisi JL. Chronic Meningitis Investigated via Metagenomic Next-Generation Sequencing. JAMA Neurol. 2018.
Baddley JW, Salzman D and Pappas PG. Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features. Clin Transplant. 2002;16:419-24.

#119 Say WHAT? Aug 30, 2018

Show notes

The sudden onset of vertigo can turn your world upside down. Literally. "I felt like I was going to die," Mike said, as it was happening to him. This week on the show, a patient (and a neurologist) recounts his experience with an acute neurologic syndrome, and its long-term consequences.

Produced by James E. Siegler and Michael Rubenstein. Music by Axletree, Chris Zabriskie, Heftone Banjo Orchestra, and Lee Rosevere. Sound effects by Mike Koenig, Daniel Simion. Voiceover by Dr. Ali Hamedani. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Lee H, Sohn SI, Jung DK, Cho YW, Lim JG, Yi SD, Lee SR, Sohn CH and Baloh RW. Sudden deafness and anterior inferior cerebellar artery infarction. Stroke; a journal of cerebral circulation. 2002;33:2807-12.
Baloh RW. Clinical practice. Vestibular neuritis. The New England journal of medicine. 2003;348:1027-32.
Lee H, Kim JS, Chung EJ, Yi HA, Chung IS, Lee SR and Shin JY. Infarction in the territory of anterior inferior cerebellar artery: spectrum of audiovestibular loss. Stroke; a journal of cerebral circulation. 2009;40:3745-51.
Kattah JC, Talkad AV, Wang DZ, Hsieh YH and Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke; a journal of cerebral circulation. 2009;40:3504-10.
Beyea JA, Agrawal SK and Parnes LS. Recent advances in viral inner ear disorders. Curr Opin Otolaryngol Head Neck Surg. 2012;20:404-8.

#13 The broken heart syndrome Aug 23, 2018

Show notes

When the heart stops working, the brain stops working. But if the brain stops working, does the heart shut down? In this episode, Dr. David Manly (Duke Cardiology) discusses the pathogenesis and management of the reversible syndromes of neurogenic stress cardiomyopathy. In full disclosure, this is a re-mastered re-run of a prior episode posted June 29, 2016. With some updates at the end.

Produced by James E. Siegler. Music by Lee Rosevere. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

1. Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118:397-409

2. Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5:22-29

3. Paur H, Wright PT, Sikkel MB, Tranter MH, Mansfield C, O'Gara P, et al. High levels of circulating epinephrine trigger apical cardiodepression in a beta2-adrenergic receptor/gi-dependent manner: A new model of takotsubo cardiomyopathy. Circulation. 2012;126:697-706

4. Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA : the journal of the American Medical Association. 2011;306:277-286

5. Banki NM, Kopelnik A, Dae MW, Miss J, Tung P, Lawton MT, et al. Acute neurocardiogenic injury after subarachnoid hemorrhage. Circulation. 2005;112:3314-3319

6. Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, et al. Takotsubo cardiomyopathy in acute ischemic stroke. Annals of neurology. 2008;64:547-554

7. Grabowski A, Kilian J, Strank C, Cieslinski G, Meyding-Lamade U. Takotsubo cardiomyopathy--a rare cause of cardioembolic stroke. Cerebrovascular diseases. 2007;24:146-148

8. Finsterer J, Wahbi K. Cns-disease affecting the heart: Brain-heart disorders. Journal of the neurological sciences. 2014;345:8-14

9. Stiermaier T, Moeller C, Oehler K, Desch S, Graf T, Eitel C, Vonthein R, Schuler G, Thiele H and Eitel I. Long-term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences. European journal of heart failure. 2016;18:650-6.

#118 Subcortical kinds of cortical signs Aug 16, 2018

Show notes

Lesion localization is a critical skill for any neurologist. The so-called "cortical signs" are symptoms or exam findings which are often associated with cortical neuron injury--aphasia, neglect, gaze preference. But they are also seen after injury to subcortical structures, including white matter tracts, the thalamus, and basal ganglia. In this week's installment of the BrainWaves podcast, we'll attempt to localize subcortical lesions based on these major cortical signs.

Produced by James E. Siegler. Music by Aussenseiter, Gnagno, Yshwa, and Kevin McLeod. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Maeshima S and Osawa A. Thalamic Lesions and Aphasia or Neglect. Current neurology and neuroscience reports. 2018;18:39.
Bogousslavsky J, Regli F and Uske A. Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology. 1988;38:837-48.
Karnath HO, Himmelbach M and Rorden C. The subcortical anatomy of human spatial neglect: putamen, caudate nucleus and pulvinar. Brain. 2002;125:350-60.
Lam YW and Sherman SM. Functional organization of the thalamic input to the thalamic reticular nucleus. J Neurosci. 2011;31:6791-9.
Tijssen CC. Contralateral conjugate eye deviation in acute supratentorial lesions. Stroke; a journal of cerebral circulation. 1994;25:1516-9.
Fridriksson J, den Ouden DB, Hillis AE, Hickok G, Rorden C, Basilakos A, Yourganov G and Bonilha L. Anatomy of aphasia revisited. Brain. 2018. Epub ahead of print.
Nadeau SE and Crosson B. Subcortical aphasia. Brain Lang. 1997;58:355-402; discussion 418-23.

#117 Top-down visual processing: From photoreceptors to grandmother neurons Aug 02, 2018

Show notes

How visual information transforms from pixels into people is more complex than dots becoming lines, lines becoming shapes, and shapes becoming faces. Your brain makes assumptions about all kinds of sensory information--even without you knowing it. Dr. Geoffrey Aguirre, a neuroscientist who specializes in vision processing, explains how we know what we can't really explain.

Produced by James E. Siegler & Geoff Aguirre. Music by Cullah, Jon Watts, Lovira, Loyalty Freak Music, and Scott Holmes. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Thompson P. Margaret Thatcher: a new illusion. Perception. 1980;9:483-4.
Psalta L, Young AW, Thompson P and Andrews TJ. The Thatcher illusion reveals orientation dependence in brain regions involved in processing facial expressions. Psychol Sci. 2014;25:128-36.

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